Osteotomy for Revision Total Hip Replacement

Discussion. We previously reported bone and fat levels some I 2 times higher than those after systemic injection (Hoddinott et al 1990) and have now extended our sampling to provide a pharmacokinetic profile over the important 24 hours after operation (Fig. 1). The results indicate that the regional intravenous administration of a single 750 mg dose of cefuroxime gave satisfactory haematoma levels for at least 20 hours in all our patients. The main reservoir for the antibiotic during this period is the bone, and bone levels are therefore probably higher than the haematoma level. Our results suggest that a single dose of cefuroxime is adequate for postoperative prophylaxis, dispensing with the need for further systemic injections. Our numbers are too small to allow us to comment on infection rates, but it does seem logical to provide the maximum available antibiotic level at the operation site during the surgical procedure. We recommend the use of the regional intravenous injection of a single dose of prophylactic antibiotic for knee arthroplasty performed under tourniquet.